More than 10,000 baby boomers are turning 65 with each passing day and statistics show that by 2030, all boomers will be at least 65 years old. This means that the number of home-limited and homebound patients is going to increase dramatically over the next few years. Before the pandemic, only about 12% of home-limited patients were receiving home-based primary care.
While rising healthcare costs and disease burden have already contributed to pushing in-home primary care services forward, the Covid-19 crisis has catalyzed the way people think about how they receive quality medical care.
At-home primary care, or “house calls”, aims to deliver care to patients who face barriers accessing care outside their homes. Without access to community resources and providers such as primary care physicians, physician assistants and nurse practitioners visiting them at home, these patients usually have no other means to receive consistent follow-up care. This exacerbates the cycle of poor health management ongoing which negatively impacts patients and their caregivers while driving up costs for payers.
The concept of a house call is nothing new. Up until a few decades ago, it was common for family physicians to make house calls, stethoscopes around their necks and black bags in hand. It is estimated that nearly 40% of health care was delivered in the home in the 1930s.
This model largely became obsolete by the late 20th century, pushed aside by mega health systems and office-centered practice. By 1980, less than 1% of care provided by primary health care providers took place in patients’ homes. Over time, patient care moved to urgent care facilities, emergency departments, hospitals, clinics, and physician offices. With the growing needs of seniors and people in other at-risk groups to be able to access reliable primary care at home, leading service providers are starting to offer in-home health care to bridge the care gap in the 21st century.
An important player in today’s home-based health care system is technology. With electronic medical records, doctors can access patients’ charts virtually anywhere. Blood and lab tests can be conducted in the comfort of the patient’s home within minutes, and portable ultrasound and x-rays equipment are now also available.
A smartphone today can function as an ultrasound console, an electrocardiogram, and a portal to access medical references (like drug databases and textbooks) and transmit paperwork with remote scanning and printing.
In addition to improving the quality of care for patients, in-home primary care can radically reduce missed appointments, fragmented care, medical emergencies, and the poor control of chronic conditions. These factors are responsible for acute hospitalizations, hospital readmissions, emergency room visits, and institutionalization of at-risk patients.
By providing primary care or specialty care in a patient’s home, stress and other challenges faced by patients and their family members or care providers can also be eliminated.
Moreover, home-based primary care allows Medicare Advantage programs and Accountable Care organizations (ACOs) to strive for care quality improvement for their most costly patients. It drastically reduces the costs associated with expensive medical home or nursing home services while boosting patient satisfaction.
These facts about in-home primary care have been well-documented. In 2012, the Independence At Home (IAH) Medicare House Call Demonstration program was launched to test the efficacy of the in-home primary care model to help chronic care and acute care patients age in place. It was also meant to determine whether the model could reduce Medicare costs and improve care quality.
In the first four years alone, IAH was able to achieve millions of dollars in savings, including an average reduction of about $2,800 per beneficiary. Patients had fewer emergency department visits, hospitalizations, and 30-day readmissions. Care quality was also increased in all areas, such as medication reconciliation and follow-up within 48 hours of hospitalization.
In addition to improving access to qualified primary care providers at home, in-home primary care offers additional benefits. For example, for primary care providers, it offers them a rewarding experience as many doctors feel that home-based care brings meaning and compassion back to their practice. For homebound patients, it gives them the opportunity to live a more comfortable life on their own terms. For their caregivers, it brings them peace of mind and assurance that a high-quality care provider is just one phone call away.
For health plans and the broader health care system, home-based primary care has many benefits including reduced hospitalizations of at-risk elderly patients who are usually poor surgical candidates and require long-term stays. With the emerging value-based, patient-centered paradigm, this model can also minimize costs for bundled payments and ACOs.
The whole idea of home-based primary care is to bring medical care to the patient wherever they call home in order to bridge the care gap. This clearly includes providing urgent care as needed, but its main focus is to provide visits by Advanced Practice Providers on a regular basis. For example, at Emcara Health, our in-home primary care services are ideal for people who:
In-home primary care can be incredibly useful for people who are suffering from a wide range of chronic, complex conditions, such as diabetes, COPD, Alzheimer’s, dementia, chronic wounds, heart disease, Parkinson’s, and conditions that require home ventilator support. A patient’s physical and behavioral health care needs can be very effectively addressed right where they live.
For some patients, it can be challenging to personally visit a doctor for proper care. However, missing out on their medical appointments can increase their risk of hospitalizations and Emergency Room visits. Emcara Health provides in-home primary care to these patients in the comfort of their own homes.
Our team of board-certified physicians, nurse practitioners, registered nurses ,behavioral health experts, social workers, community health navigators, community health workers and care navigators who receive specialized support from dieticians, physical therapists and palliative Care professionals focus on building trusted relationships with patients and enabling them to participate in how their own care is administered.
We make use of remote monitoring, telehealth visits, portable diagnostics, and many other mobile technologies to bring the doctor’s office to the patient’s home. We work with a variety of plans, including ACA, Medicare Advantage, and Managed Medicaid, to reduce the total cost of care by addressing the holistic needs of patients. For more information, you can reach out to us online or give us a call at 615-721-7020.
